The inspection took place on 13 and 17 September 2018 and was announced to ensure staff we needed to speak with were available. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults, younger disabled adults, people living with dementia or mental health needs. On the first day of the office site visit the service was providing the regulated activity of personal care to 51 people.

The provider had addressed a period of instability in the management of the service by the appointment of one of their established and experienced managers from another of their locations. The new manager had submitted their application to become the registered manager for the service and this was being processed. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in May 2017 we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as the provider had failed to provide people with person centred care. At this inspection we found the requirements of this regulation had now been met. People received personalised care that was planned with them and was responsive to their needs. People’s care plans reflected their expected outcomes and any preferences they had about the delivery of their care. The care was regularly reviewed or sooner if their care needs changed. People were supported to pursue their interests where this was commissioned. The service has been rated as requires improvement overall for a second time, as although improvements to the service have been made, further time is required for the manager to complete and embed them across the service.

People were safeguarded from the risk of abuse. Staff had undergone relevant training and understood their role and responsibilities. The provider had identified those staff who needed to update their annual safeguarding training to ensure their knowledge remained relevant and this work was underway. Potential risks to people in relation to a range of aspects of their care had been assessed and where required measures were in place to manage them. Processes were in place to ensure risks were regularly reviewed. Staff had undertaken infection control training and understood their responsibilities in this area. Processes were in place to identify and apply any learning points from incidents.

There were sufficient staff to provide people’s care, but following a recent loss of some staff, some people reported their calls were not always delivered in a timely manner and that there was less consistency in their staffing. The provider was aware of this issue and relevant action had been taken to rectify this for people.

People received their medicines from trained staff. Improvements were required to ensure all staff always signed people’s medicine administration records in addition to recording in people’s daily notes they had received their medicine, to ensure a complete record was maintained.

People’s assessments and care planning reflected relevant legislation and guidance. The provider ensured staff had the required skills, knowledge and experience to support the people they cared for. Staff were supported to undertake relevant training for their role. Staff were adequately supported in their role with regular supervisions and spot checks of their practice.

Staff supported people to receive sufficient food and drink for their needs, both during and between visits. Staff worked with relevant agencies to ensure people received co-ordinated care and that their health care needs were met.

People were supported to have maximum choice and control of

This announced inspection took place on 24, 25 and 30 May 2017. Abicare Service Ltd provides a domiciliary care service to enable people living in Basingstoke, Aldershot and the surrounding areas to maintain their independence at home. At the time of our inspection there were 66 people using the service, who had a range of health and social care needs. Some people were being supported to live with dementia and autism, whilst others were supported with specific health conditions including epilepsy, diabetes, learning disabilities and mental health diagnoses. At the time of the inspection the provider deployed 25 staff to provide 520 hours care per week to meet people’s assessed needs.

At the time of the inspection the service had a registered manager, however they had recently tendered their resignation. The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were kept safe as staff understood their role and responsibility in relation to safeguarding procedures. Staff had undergone safeguarding training and understood the different types of abuse and how to recognise signs of such abuse.

Risks to people had been initially assessed and control measures put in place to minimise their occurrence. However, these were not reviewed regularly to ensure the most up to date guidance was provided to staff. This meant the provider could not be assured that all risks to people were being managed appropriately to keep people safe. One person had experienced a fall whilst being supported by staff which demonstrated staff did not always consistently apply safe moving and positioning practices. The registered manager had identified that some people’s risk assessments had not been regularly reassessed and was in the process of ensuring this work was completed as a priority.

The registered manager completed a daily staffing needs analysis to ensure there were sufficient staff deployed to meet people’s needs. However, this frequently required the registered manager, care coordinator and community team leaders to work overtime to provide hands on care, which deflected them from other responsibilities, such as reviewing care plans and risk assessments.

Records demonstrated the service had a recruitment process that met legal requirements and recruitment files confirmed that most required pre-employment checks had been completed. However, the provider had not consistently followed their own recruitment processes and taken appropriate action to assure themselves that staff employed were of suitable character to support people safely.

People’s medicines were administered by suitably trained staff, although the provider had not consistently assured their knowledge and skill to do so had been maintained.

The provider’s required training had not been updated in accordance with the provider’s policy. This meant that the provider had not ensured staff were supported to maintain their skills at the required standard to meet people’s assessed needs effectively.

People’s care and support was always provided with their consent, although records did not always clearly reflect this. The registered manager and staff ensured best interest meetings and processes were followed to protect people’s human rights.

Staff encouraged people to eat and drink sufficiently to maintain their health.

People and their relatives had a mixed experience in relation to the caring attitudes of the staff supporting them. Regular staff were caring and compassionate and treated people with respect although some staff were task focused and did not show an appreciation of the need to meet people’s emotional wellbeing.

People were involved in making